Description:
This paper investigates events in which cyclists perceive a cycling crash is narrowly avoided (henceforth, a near miss). A cohort of 2038 adult transport and recreational cyclists from New South Wales (Australia) provided self-reported prospectively collected data from cycling diaries to allow the calculation of an exposure-based rate of near misses and investigation of near miss circumstances. During 25,971 days of cycling, 3437 near misses were reported. For a given time cycling, cyclists who rode mainly for transport (compared with those who rode mainly for recreation), and cyclists with less experience (compared to those with more experience) were more likely to report a near miss; older cyclists (60+ years) were less likely to report a near miss than younger cyclists (25-59 years). Where type of near miss was recorded, 72.0% involved motor vehicles, 10.9% involved pedestrians and 6.9% involved other cyclists. Results indicate some similarities between near misses and crashes reported by this cohort during the same reporting period. A bias toward reporting near misses with motor Vehicles was suggested, which likely reflects cyclists' perceptions that crashes involving motor vehicles are particularly serious, and highlights their impact on perceived safety. Given the relative rarity of crashes, and the limited breadth and depth of administrative data, collection of near miss data may contribute to our understanding of cycling safety by increasing the volume and detail of information available for analysis. Addressing the causes of near misses may offer an opportunity to improve both perceived and actual safety for cyclists. (C) 2017 Elsevier Ltd. All rights reserved.
Description:
BACKGROUND:Previous research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs. METHODS:A total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users. RESULTS:Across the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system). CONCLUSIONS:The injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.
Description:
BACKGROUND:Previous research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs. METHODS:A total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users. RESULTS:Across the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system). CONCLUSIONS:The injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.
Description:
The researchers undertook a study involving post-graduate occupational health and safety students at the University of Ballarat designed to evaluate the effectiveness of the Australian standard for classifying accidents. The results showed that the classification scheme has significant limitations which may impact upon the setting of prevention priorities at the national, state, industry and organisational levels of the system for risk control.
Description:
The Australian Fitness Industry Risk Management (AFIRM) Project was set up to explore the operation of rules and regulations for the delivery of safe fitness services. This article summarises the results of recent focus group research and a national survey of risk management practices by the AFIRM Project. Our focus group research in four States identified the following most important concerns: (1) the competency of fitness professionals; (2) the effectiveness of pre-exercise screening and the management of de-conditioned clients; (3) poor supervision of fitness service users and incorrect use of equipment; (4) fitness trainers failing to remain within their scope of practice; (5) equipment misuse (as distinct from incorrect use); and (6) poor fitness training environments. This information was then used to develop 45 specific items for a questionnaire that was disseminated throughout the fitness industry. The survey, which is the largest ever conducted in the Australian fitness industry (n = 1,178), identified similar concerns. Our research indicates that efforts to improve risk management in the fitness industry should focus, first and foremost, on the development and monitoring of safety policy, and improvements in the education and training of fitness instructors to ensure that they can incorporate risk management practices.
Description:
Globally, injuries are the leading cause of death and represent the highest burden of ongoing disease amongst children 1–16 years of age. Increasingly, prevention programmes are recognising a growing need for intervention strategies that target children. The purpose of this study was to determine the efficacy of the SeeMore Safety Programme, designed to teach children (4–6 years of age) how to make conscious decisions about their own capabilities related to safety and how to manage risk. This retrospective study examined de-identified pre- and post-programme data from a sample of 1027 4 to 6-year-old pre-school children over the four-year period who participated in the SeeMore Safety Programme. Results show a significant improvement in each of the post-test scores and when compared to the pre-test scores (p < 0.001). Children from rural areas, as well as those from areas of greater disadvantage, also showed significant improvement in their pre- and post-test scores (p < 0.001). Overall, the findings highlight that the SeeMore Safety Programme over the four-year period demonstrates an increase in the children’s capacity to recognise and identify danger and safety amongst all children, offering great promise for reducing the burden of injury on children, their families and society.
Description:
Globally, injuries are the leading cause of death and represent the highest burden of ongoing disease amongst children 1–16 years of age. Increasingly, prevention programmes are recognising a growing need for intervention strategies that target children. The purpose of this study was to determine the efficacy of the SeeMore Safety Programme, designed to teach children (4–6 years of age) how to make conscious decisions about their own capabilities related to safety and how to manage risk. This retrospective study examined de-identified pre- and post-programme data from a sample of 1027 4 to 6-year-old pre-school children over the four-year period who participated in the SeeMore Safety Programme. Results show a significant improvement in each of the post-test scores and when compared to the pre-test scores (p < 0.001). Children from rural areas, as well as those from areas of greater disadvantage, also showed significant improvement in their pre- and post-test scores (p < 0.001). Overall, the findings highlight that the SeeMore Safety Programme over the four-year period demonstrates an increase in the children’s capacity to recognise and identify danger and safety amongst all children, offering great promise for reducing the burden of injury on children, their families and society.
Description:
Aim We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. Context This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details. Approach An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is ‘nothing about Indigenous people, without Indigenous people’ in rural health research publications. Conclusion Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals “Editing with IndigenUs and for IndigenUs”.
Description:
Autonomous mobility is fundamental for older Australians to participate in the activities that occupy and inspire daily life. Should a mobility difficulty arise, a powered mobility device (PMD) can assist to supplement or restore mobility, choice, and control. A PMD continues to be a valued resource once a person moves into residential aged care. However, increasing frailty among people within this group means that incidents can result in serious injury for PMD users or others living, visiting, or working in this environment. Guidelines for PMD use are available, however, there are no regulations or mandates to seek professional guidance for assessment of competence, equipment prescription, or training. Occupational therapy theory and practice can support all parts of this process. This thesis presents a three-part study using a mixed methods approach to (i) examine PMD use related incidents and injuries within residential aged care, (ii) to evaluate existing measurement tools, and (iii) to develop and undertake initial validation of a new screening tool developed for residents who use PMDs, based on classical test theory (De Vellis, 2006). The new screening tool will address a gap identified among screening tools for PMD capacity and performance skills specific to this population, to improve the balance between much needed autonomy and safety for all stakeholders.
Description:
Autonomous mobility is fundamental for older Australians to participate in the activities that occupy and inspire daily life. Should a mobility difficulty arise, a powered mobility device (PMD) can assist to supplement or restore mobility, choice, and control. A PMD continues to be a valued resource once a person moves into residential aged care. However, increasing frailty among people within this group means that incidents can result in serious injury for PMD users or others living, visiting, or working in this environment. Guidelines for PMD use are available, however, there are no regulations or mandates to seek professional guidance for assessment of competence, equipment prescription, or training. Occupational therapy theory and practice can support all parts of this process. This thesis presents a three-part study using a mixed methods approach to (i) examine PMD use related incidents and injuries within residential aged care, (ii) to evaluate existing measurement tools, and (iii) to develop and undertake initial validation of a new screening tool developed for residents who use PMDs, based on classical test theory (De Vellis, 2006). The new screening tool will address a gap identified among screening tools for PMD capacity and performance skills specific to this population, to improve the balance between much needed autonomy and safety for all stakeholders.
Description:
Bronchial thermoplasty induces atrophy of the airway smooth muscle layer, but the mechanism whereby this improves patient health is unclear. In this study, we use computed tomography (CT) to evaluate the effects of bronchial thermoplasty on airway volume 12 months post-procedure. 10 consecutive patients with severe asthma were evaluated at baseline by the Asthma Control Questionnaire (ACQ), and high-resolution CT at total lung capacity (TLC) and functional residual capacity (FRC). The CT protocol was repeated 4 weeks after the left lung had been treated by bronchial thermoplasty, but prior to right lung treatment, and then again 12 months after both lungs were treated. The CT data were also used to model the implications of including the right middle lobe (RML) in the treatment field. The mean patient age was 62.7 +/- 7.7 years and forced expiratory volume in 1 s (FEV1) 42.9 +/- 11.5% predicted. 12 months post-bronchial-thermoplasty, the ACQ improved, from 3.4 +/- 1.0 to 1.5 +/- 0.9 (p=0.001), as did the frequency of oral steroid-requiring exacerbations (p=0.008). The total airway volume increased 12 months after bronchial thermoplasty in both the TLC (p=0.03) and the FRC scans (p=0.02). No change in airway volume was observed in the untreated central airways. In the bronchial thermoplasty-treated distal airways, increases in airway volume of 38.4 +/- 31.8% at TLC (p=0.03) and 30.0 +/- 24.8% at FRC (p=0.01) were observed. The change in distal airway volume was correlated with the improvement in ACQ (r=-0.71, p=0.02). Modelling outputs demonstrated that treating the RML conferred no additional benefit. Bronchial thermoplasty induces long-term increases in airway volume, which correlate with symptomatic improvement.
Description:
Bronchial thermoplasty induces atrophy of the airway smooth muscle layer, but the mechanism whereby this improves patient health is unclear. In this study, we use computed tomography (CT) to evaluate the effects of bronchial thermoplasty on airway volume 12 months post-procedure. 10 consecutive patients with severe asthma were evaluated at baseline by the Asthma Control Questionnaire (ACQ), and high-resolution CT at total lung capacity (TLC) and functional residual capacity (FRC). The CT protocol was repeated 4 weeks after the left lung had been treated by bronchial thermoplasty, but prior to right lung treatment, and then again 12 months after both lungs were treated. The CT data were also used to model the implications of including the right middle lobe (RML) in the treatment field. The mean patient age was 62.7 +/- 7.7 years and forced expiratory volume in 1 s (FEV1) 42.9 +/- 11.5% predicted. 12 months post-bronchial-thermoplasty, the ACQ improved, from 3.4 +/- 1.0 to 1.5 +/- 0.9 (p=0.001), as did the frequency of oral steroid-requiring exacerbations (p=0.008). The total airway volume increased 12 months after bronchial thermoplasty in both the TLC (p=0.03) and the FRC scans (p=0.02). No change in airway volume was observed in the untreated central airways. In the bronchial thermoplasty-treated distal airways, increases in airway volume of 38.4 +/- 31.8% at TLC (p=0.03) and 30.0 +/- 24.8% at FRC (p=0.01) were observed. The change in distal airway volume was correlated with the improvement in ACQ (r=-0.71, p=0.02). Modelling outputs demonstrated that treating the RML conferred no additional benefit. Bronchial thermoplasty induces long-term increases in airway volume, which correlate with symptomatic improvement.
Description:
A reliability optimization model is proposed in this paper for multi-state weighted k-out-of-n systems. In this model, income generated by components through each functioning period is used as a reliability index. Therefore, time value of money is used in the presented optimization model to estimate both system's reliability and cost. The system reliability is evaluated by Universal Generating Function (UGF). The model's objective function is to maximize the net present value (NPV) of the system. Therefore, it would maximize the system reliability and minimize the system cost simultaneously. A numerical example is presented in this paper to illustrate the model by finding the optimal design of the system, and the best time for maintenance plan. Also, a discussion is provided based on the result.
Description:
Risk matrices are used during hazard identification and risk assessment processes and provide a construct for people needing to display the two variable relationship between likelihood and consequence that are considered to be the elements of risk. The purpose of a matrix is to reduce the continuum of risk into ranges or bands such as high, medium or low. These bands are often allocated colours such as red for the highest risks to green for the lowest. Sometimes each band in a matrix is allocated a numerical value or range. The multiplication of likelihood and consequence implies a quantitative basis although it may not be widely understood. The multiplication operator produces lines of equal risk that a matrix cannot model accurately and thereby introduces risk reversal errors. Weaknesses in matrices are further compounded by subjectivity and bias introduced by users and the value of such tools is brought into doubt. A shift of emphasis from the risk assessment stage to the risk control stage of a hazard management process may lead to better and more timely decision making and better use of resources.
Creating safety : intersection of healthcare and police response to violence against immigrant south asian women in British Columbia : a service provision model
Description:
Background Intimate Partner Violence (IPV), is an internationally prevalent health and safety issue impacting women. Immigrant South Asian women (ISAW) in British Columbia (BC) remain vulnerable to serious injuries and homicides despite efforts of healthcare and police services. It is critical to improve these responses. Knowledge of the challenges to responses can inform and improve services and the well-being of ISAW. Aims This study aimed to explore the needs of ISAW and the challenges of healthcare and police responses, how these may inform responses and to compare the perspectives of survivors, responders and experts to improve the health and safety of ISAW. Methods Design: a two-phased, mixed methods study. Phase 1: a purposive sample of 4 focus groups of 22 ISAW survivors from four cities in BC. An additional focus group involved five subject matter experts. Also conducted were seven face-to-face semi-structured interviews with twelve key informants. Phase 2: a convenience sample of 128 provincial responders completed an online survey. Results The key emerging themes for survivors were the difficulties in identifying and disclosing IPV and the responses to IPV. Responders identified the gaps in services, culturally and linguistically inappropriate policies and uncoordinated and non-collaborative efforts. For the ISAW, perceptions, fears, and socio-cultural impediments hindered their disclosure of IPV. They required culturally and linguistically trauma informed responses, policies and practices to overcome multiple and complex challenges. Co-ordinated, collaborative systemic responses to improve the health and safety of ISAW were identified by all participants, including appropriate risk assessment. Conclusion This study adds to current knowledge by contributing to the understanding of IPV of ISAW from different perspectives: ISAW survivors, responders and experts. This knowledge offers potential improvements to services and policy developments to reduce the health and safety risks to IPV survivors.
Description:
Background Intimate Partner Violence (IPV), is an internationally prevalent health and safety issue impacting women. Immigrant South Asian women (ISAW) in British Columbia (BC) remain vulnerable to serious injuries and homicides despite efforts of healthcare and police services. It is critical to improve these responses. Knowledge of the challenges to responses can inform and improve services and the well-being of ISAW. Aims This study aimed to explore the needs of ISAW and the challenges of healthcare and police responses, how these may inform responses and to compare the perspectives of survivors, responders and experts to improve the health and safety of ISAW. Methods Design: a two-phased, mixed methods study. Phase 1: a purposive sample of 4 focus groups of 22 ISAW survivors from four cities in BC. An additional focus group involved five subject matter experts. Also conducted were seven face-to-face semi-structured interviews with twelve key informants. Phase 2: a convenience sample of 128 provincial responders completed an online survey. Results The key emerging themes for survivors were the difficulties in identifying and disclosing IPV and the responses to IPV. Responders identified the gaps in services, culturally and linguistically inappropriate policies and uncoordinated and non-collaborative efforts. For the ISAW, perceptions, fears, and socio-cultural impediments hindered their disclosure of IPV. They required culturally and linguistically trauma informed responses, policies and practices to overcome multiple and complex challenges. Co-ordinated, collaborative systemic responses to improve the health and safety of ISAW were identified by all participants, including appropriate risk assessment. Conclusion This study adds to current knowledge by contributing to the understanding of IPV of ISAW from different perspectives: ISAW survivors, responders and experts. This knowledge offers potential improvements to services and policy developments to reduce the health and safety risks to IPV survivors.
Description:
OBJECTIVES: An assessment of linked data was used to investigate the scope and the extent to which hospitalisations data and police crash records represent road crashes in New South Wales (NSW). METHODS: Hospital separation records for the period 1 July 2000 to 30 June 2001, inclusive, were linked to police crash casualty records for the same period using probabilistic record linkage techniques. Multivariable logistic regression techniques were used to identify factors independently associated with the probability of record linkage. RESULTS: Of 17,552 road transport-related hospital records, 45.1% matched to police crash casualty records. When the analysis was restricted to road traffic crashes, 69.2% of the 9,178 records had a matching police crash casualty record. Multivariable analysis found the most significant factors contributing to the likelihood of linkage to be road user type, payment status and principal diagnosis of injury variables. Motor vehicle controllers, cases entitled to financial compensation and cases with a principal diagnosis of injury were significantly more likely to be linked than all other cases. CONCLUSIONS: The findings indicate that researchers and policy makers should be cautious when examining traffic crashes based on a separate analysis of the hospitalisations data and police crash records. This is particularly true for crashes involving pedestrians, cyclists and motorcyclists, and those resulting in less severe injuries. IMPLICATIONS: The findings have implications for use of both police crash records and hospital records in informing the development of strategies designed to prevent road trauma in the community.
Description:
Objective: To identify independent factors associated with caregiver supervision levels at beaches. Methods: Children (aged 1-14 years) engaged in beach play and their caregivers were observed at Australian beaches during September-April, 2008/09. Caregiver, child, and environmental factor data were collected and recorded on a validated observation instrument. The main outcome of interest was a continuous measure of supervision. After adjusting for potential clustering by beach/state, multivariable linear regression was used to identify independent factors associated with caregiver supervision. Results: Four independent predictors of supervision and one interaction effect (child age by the caregiver and child position on beach) were identified. Caregivers who were supervising from a different position to where the child was playing were less likely to provide high supervision, as were older caregivers (>35 years) compared to younger caregivers (≤34 years). Compared to children playing alone, children playing with one, or two or more others were less likely to receive high supervision, and children aged 1-4 years were likely to receive higher supervision than older children. Conclusion: This study provides new knowledge about underlying factors associated with the level of caregiver supervision in beach settings. Future studies should continue to explore independent predictors of supervision so that effective programmes, which focus on caregiver supervision, can be targeted to address poor supervision practices.
Description:
AIM: to assess the impact of a training programme on nurse confidence in: setting up the Graseby syringe driver (GSD); explaining the GSD to patient and family; setting the rate on the GSD; putting appropriate type and dose of drugs in the GSD. STUDY DESIGN: training programme with pre-training, post-training and follow-up questionnaires. SAMPLE AND SETTING: palliative care nurse consultants presented half-day training sessions to 270 non-specialist nurses throughout the rural Grampians Health Region of Victoria, Australia. Nurses were from rural acute and sub-acute care settings, aged care facilities, and district nursing and nurse education services. MEASUREMENTS: demographic details of participants, previous experience and training with GSDs, comparative analyses of the four confidence parameters and participants' assessment of interest, new knowledge and usefulness of the training programme. Results: increases in confidence levels were found in participating nurses in relation to each of the four confidence parameters. A follow-up survey tested residual benefit three months after the training programme. Statistically significant variations were found in nurses' confidence levels in relation to frequency of use. CONCLUSIONS: regular use of, and/or refresher sessions about the GSD are recommended to maintain optimum confidence, effective and safe nursing use of the GSD in palliative care.